Hepatitis B is a liver disease caused by a virus. Undiagnosed, it can progress to cirrhosis or even liver cancer. With 350 million people affected worldwide, it is one of the most common chronic diseases. This article will bring you a simple understanding of this disease.
Introduction: the six hepatitis viruses
Hepatitis is a generic term under which we group diseases characterized by inflammation of the liver. Two types of agents can cause hepatitis: viruses and toxic products (alcohol, medicine, etc.). This is referred to respectively as viral hepatitis and toxic hepatitis.
Viral hepatitis, by far the most common in the world, can be caused by six different viruses: A, B, C, D, E and G. There is no hepatitis F.
The hepatitis A (HAV) and hepatitis E (HEV) viruses are transmitted in unsanitary conditions, via contaminated water or food; they are found in the stools of infected people. Both viruses cause acute hepatitis which disappears after a few weeks of development. The disease associated with HEV is often more discreet than that associated with HAV.
Hepatitis D is caused by an HBV covirus that only affects people who are already infected with it. Both viruses use the same routes of transmission. Protecting against HBV helps protect against HDV.
The hepatitis G virus (HGV) is transmitted through blood and causes few symptoms.
Understanding hepatitis B
Chronic hepatitis B is a disease caused by the hepatitis B virus (HBV). The infection most often remains symptomless for many years. Undiagnosed, it can evolve and expose infected people to a high risk of cirrhosis, then liver cancer.
A highly contagious virus
The hepatitis B virus is easily transmitted through blood, semen and vaginal secretions. New infections mainly occur during unprotected sex with an infected person. At the same time, sharing injection or drug use equipment is a possible route of contamination for drug addicts.
HBV is a virus much more contagious than HIV: it can therefore be transmitted to those around the infected person through equipment soiled with traces of blood (nail clippers , razor, earrings…), or via poorly disinfected equipment used for acupuncture, tattooing, piercing…
HBV can also be transmitted from mother to child during pregnancy or childbirth, if the mother is not treated (transmission of the virus observed in 40 to 90% of cases). This mode of contamination is very important in countries that do not have an effective health system.
An infection that is difficult to spot in the early stages
HBV causes acute hepatitis occurring one to six months after infection. This manifestation corresponds to a phase of significant mobilization of immunity against the active replication of the virus: the body's defense mechanisms destroy the infected cells, causing fever in half of the cases, nausea, vomiting, dark urine, whitish stools…. In others, this phase remains symptomless.
In approximately 1% of patients, hepatitis is said to be fulminant: the mechanisms of liver degradation are then major and involve the vital prognosis. These patients require urgent liver transplantation.
At the end of acute hepatitis B, approximately 90% of infected adults get rid of the virus. The others remain permanently contaminated and develop chronic hepatitis B. It is difficult to predict which people will or will not be able to eliminate the virus from their body: the general state of the person, their alcohol consumption, the presence of concomitant infections and many other factors can influence the disease progression. We also know that the risk of becoming chronic is all the higher when contamination occurs at an early age.
Late complications
Chronic hepatitis B is a disease that remains silent for many years. But during this period, the virus causes liver damage. Infected liver cells are eliminated by the immune system, then gradually replaced by fibrous scar tissue. If left untreated, fibrosis progresses and can lead to the development of cirrhosis. At this stage, we speak of hepatocellular insufficiency. The capacity of the liver to carry out its usual functions is limited and the symptoms are multiple: jaundice (jaundice), increase in the size of the liver (hepatomegaly), risk of haemorrhage of the esophagus or the digestive tract... Eventually, cirrhosis can progress to a liver cancer (hepatocarcinoma or hepatocellular carcinoma).
Focus on early detection
In practice, the diagnosis of HBV infection is often made when the patient consults a doctor because of late symptoms of the disease. Hepatitis B then reached a severe stage that current treatments only partially relieve. Early detection of the disease, at the asymptomatic stage, is essential to limit the consequences of chronic infection.
Failing to be vaccinated, experts recommend individual screening for the infection at least once in life, simultaneously with HIV and HCV. It is also recommended to carry out regular screenings after any behavior at risk of contamination (unprotected sexual intercourse, prolonged trip to an endemic area, etc.). Screening is also systematically carried out in pregnant women.
HBV can be tested as early as the third month following infection. Screening is based on a blood test. Several markers are sought, some being constituents of the virus – HBs and HBe antigens (Ag) – others being evidence of the patient's immune defenses developing against the virus – anti-HBs and anti-HBc antibodies (Ab).
The presence of HBs antigen in the blood signifies the presence of the HBV virus in the body.
The treatments
HBV is a DNA virus and its genome can integrate into that of infected cells. This is why it is difficult to eradicate HBV from the body once the disease has become chronic. Current pharmaceutical treatments only control the replication of the virus, thus limiting the consequences of the infection on the liver. They do not completely cure the infection or liver damage.
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